Background
Obesity-related non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are two main causes of end-stage liver disease requiring a liver transplantation. Studies ...exploring bariatric surgery in the liver transplantation setting have increased in recent years; however, a systematic analysis of the topic is lacking to date. This meta-analysis was conducted to explore the perioperative and long-term outcomes of bariatric surgery in obese patients undergoing liver transplantation.
Methods
Electronic databases were systematically searched for studies reporting bariatric surgery in patients undergoing liver transplantation. The primary outcomes were postoperative complications and mortality. We also extracted data about excess weight loss, body mass index, and improvement of comorbidities after bariatric surgery.
Results
A total of 96 patients from 8 articles were included. Bariatric surgery–related morbidity and mortality rates were 37% (95% CI 0.27–0.47) and 0.6% (95% CI 0.02–0.13), respectively. Body mass index at 24 months was 31.02 (95% CI 25.96–36.09) with a percentage excess weight loss at 12 and 24 months of 44.08 (95% CI 27.90–60.26) and 49.2 (95% CI 31.89–66.66), respectively. After bariatric surgery, rates of improvement of arterial hypertension and diabetes mellitus were 61% (95% CI 0.45–0.75) and 45% (95% CI 0.25–0.66), respectively. In most patients, bariatric surgery was performed after liver transplant and the most frequent technique was sleeve gastrectomy.
Conclusions
Bariatric surgery can be performed safely in the setting of liver transplantation resulting in improvement of obesity-related comorbidities. The optimal timing and technique require further studies.
Obesity represents a risk factor in case of major hepatectomy, because the future liver remnant (FLR) must be proportional with body weight. To avoid post-hepatectomy liver failure, and further ...increase the ratio between FLR and body weight, we performed a bariatric procedure in the first stage of the ALPPS technique.
Fifty-four-year-old woman, with morbid obesity (BMI 58.5) and type II diabetes mellitus, was scheduled for a major hepatectomy due to multiple colorectal liver metastases DIAGNOSIS:: Six months before, the patient was diagnosed with colorectal cancer and synchronous liver metastases. She was initially treated with sigmoidectomy and chemotherapy. After partial response of the liver metastases, we considered a liver resection but the FLR was very low, especially in relation to her BMI.
We planned a novel approach and, for the first time, we performed a sleeve gastrectomy during the first stage of Tourniquet ALPPS (T-ALPPS). After achieving an adequate FLR, we successfully completed the major hepatectomy during the second stage of T-ALPPS.
The association between sleeve gastrectomy and T-ALPPS produced an increase of FLR/body weight ratio up to 0.8 that allowed completing a right trisectionectomy in the second stage of ALPPS. The major hepatectomy was performed without severe complications, and several months after surgery the patient is still alive without any recurrence Conclusion: Despite obesity represents a risk factor involved in the carcinogenesis, the role of the bariatric surgery in the oncological setting is not well established. In this clinical case, we benefited from the weight loss produced by bariatric surgery combined with an effective hypertrophy technique and chemotherapy. These findings suggest that bariatric surgery could be useful for obese patients with liver malignancy and need for extended hepatectomy.
The study of patterns of urban mobility is of utter importance for city growth projection and development planning. In this paper, we analyze the topological aspects of the street network of the ...coastal city of Cartagena de Indias employing graph theory and spatial syntax tools. We find that the resulting network can be understood on the basis of 400 years of the city’s history and its peripheral location that strongly influenced and shaped the growth of the city, and that the statistical properties of the network resemble those of self-organized cities. Moreover, we study the mobility through the network using a simple agent-based model that allows us to study the level of street congestion depending on the agents’ knowledge of the traffic while they travel through the network. We found that a purely shortest-path travel scheme is not an optimal strategy and that assigning small weights to traffic avoidance schemes increases the overall performance of the agents in terms of arrival success, occupancy of the streets, and traffic accumulation. Finally, we argue that localized congestion can be only partially ascribed to topological properties of the network and that it is important to consider the decision-making capability of the agents while moving through the network to explain the emergence of traffic congestion in the system.
Ibrexafungerp (SCY-078) is the newest oral and intravenous antifungal drug with broad activity, currently undergoing clinical trials for invasive candidiasis.
The aim of this study was to assess the
...activity of ibrexafungerp and comparators against a collection of 434 European blood isolates of
.
Ibrexafungerp, caspofungin, fluconazole, and micafungin minimum inhibitory concentrations (MICs) were collected from 12 European laboratories for 434 blood isolates, including 163
, 108
, 60
, 40
, 29
, 20
, 6
, 2
, 2
, and 1 isolate each of
,
, and
. MICs were determined by the EUCAST broth microdilution method, and isolates were classified according to recommended clinical breakpoints and epidemiological cutoffs. Additionally, 22
from different clinical specimens were evaluated.
Ibrexafungerp MICs ranged from 0.016 to ≥8 mg/L. The lowest ibrexafungerp MICs were observed for
(geometric MIC 0.062 mg/L, MIC range 0.016-0.5 mg/L) and the highest ibrexafungerp MICs were observed for
(geometric MIC 0.517 mg/L, MIC range 0.06-≥8 mg/L). Modal MICs/MIC
s (mg/L) against
spp. were 0.125/0.06 for
, 0.5/0.5 for
, 0.25/0.25 for
, 0.5/0.5 for
, 1/1 for
, 4/2 for
, and 0.5/0.5 for
. Ibrexafungerp showed activity against fluconazole- and echinocandin-resistant isolates. If adopting wild-type upper limits, a non-wild-type phenotype for ibrexafungerp was only observed for 16/434 (3.7%) isolates: 11 (4.6%)
, 4 (5%)
, and 1 (2.5%)
.
Ibrexafungerp showed a potent
activity against
.
Las fracturas de pilón tibial son poco comunes; sin embargo, se consideran de alta complejidad. En general, se producen por mecanismos de trauma de alta energía, como fuerzas axiales sobre el ...astrágalo, lo que provoca impacto en la tibia y su fractura. Estas fracturas están asociadas con una grave afectación de los tejidos blandos, lo que las predispone a complicaciones. Por tanto, se debe tener un manejo meticuloso de estos tejidos, lo que representa un desafío para su fijación, dado que en múltiples ocasiones dificultan su abordaje.
A pesar de los avances quirúrgicos y los protocolos por etapas, así como la introducción del uso de la fijación externa provisional en el período agudo, hasta lograr un adecuado estado de los tejidos blandos, se ha reducido la tasa de infecciones y complicaciones. Sin embargo, su pronóstico continúa siendo deficiente.
Purpose
Bariatric surgery is currently considered the most effective and durable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has become a popular technique and may ...currently be the most frequently practiced surgical operation to treat obesity. However, no objective analyses of its learning curve have been reported. Objective: to analyze the learning curve for LSG.
Materials and Methods
We included all LSGs performed in our hospital (University Hospital, Spain; Public Practice) from April 2013 to February 2016. The learning curve for LSG was evaluated using cumulative sum (CUSUM) analysis. All variables among the learning curve phases were compared.
Results
According to the CUSUM analysis, the learning curve was divided into three unique phases: early learning (the initial 26 patients), acquisition of skills (the middle 30 patients), and mastery of technique (the final 56 patients). The operative time and gastric stenosis significantly decreased with progression of the learning curve without differences in the 30-day postoperative complication rate, postoperative stay, or weight loss.
Conclusion
According to this study, the learning curve for LSG can be divided into 3 distinct phases, and about 25 patients are needed to demonstrate an improvement in surgical skill.
Graphical abstract
the patients affected by systemic lupus erythematosus (SLE) often suffer gastrointestinal symptoms. The differential diagnosis should contemplate pathology of the gall bladder. We present the case of ...a patient with hemorrhagic lithiasic cholecystitis and hemobilia.
24 year old female diagnosed with SLE under treatment with Sintrom®, Dacortin® and Dolquine® that presented acute lithiasic cholecystitis and hemobilia with a distal calculus. Cholecystectomy and aperture of the ductus choledochus were performed allowing to confirm the hemobilia and to extract the calculus.
The treatment of cholecystitis in the patients with SLE is controversial due to the fact that most reviewed cases have been solved with cholecystectomy, or in other cases with conservative treatment with corticosteroids. We believe that the presence of cholelithiasis in a patient with SLE with pain on the right hypochondrium and ultrasound confirming the suspicion of cholecystitis demands a surgical treatment since the cause may be vascular, lithiasic or combined. Besides, the possible complications will not respond to pharmaceutical treatment.
OBJETIVO: Identificar y evaluar los factores que predisponen a la utilización de la prueba de Papanicolaou en la población que usa el servicio del Programa Nacional de Detección Oportuna de Cáncer en ...México. MÉTODOS: Se realizó un estudio del tipo transversal de enero de 1997 a diciembre de 1998, en la Ciudad de México; se incluyeron a 2.107 mujeres en edad reproductiva que acudieron a un servicio de planificación familiar, las cuáles respondieron a un cuestionario con preguntas sobre características: sociodemográficas, factores de riesgo reproductivo asociados a cáncer cervical, historia de vida sexual, uso de métodos anticonceptivos, conocimiento de la utilidad y utilización del Papanicolaou. Para el análisis de los datos se construyeron modelos multivariados de regresión logística no condicional. RESULTADOS: Los predisponentes de utilización del programa de detección oportuna de cáncer en esta población fueron: el conocimiento de la utilidad del Papanicolaou incrementó en seis veces más la posibilidad de utilización (IC 95% 4,70-7,67); el antecedente de utilización de dos o más métodos de planificación familiar (OR=2,38; IC 95% 1,75-3,24); el antecedente de historia de infección vaginal (OR=2,18; IC 95% 1,73-2,75), y la aceptación del esposo para la realización de exploraciones ginecológicas (OR=1,56; IC 95% 1,07-2,29). CONCLUSIONES: La implementación de programas educativos en la prevención de cáncer, deberán incluir la utilidad de las pruebas de detección. En México, en mujeres en edad reproductiva utilización de la prueba de Papanicolaou se ofrece predominantemente en forma oportunista, por lo que el antecedente de utilización de los Servicios de Salud es un determinante para la utilización del Programa de Detección Oportuna de Cáncer Cervical. Estos resultados muestran la necesidad de ampliar la promoción a la salud de este programa a las mujeres de alto riesgo, incluyendo a sus parejas sexuales.
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